I was recently diagnosed with adenocarcimona in situ. I have to have a cone biopsy. Let me tell you, at first I was COMPLETELY freaked out, but I have since calmed down.
Okay, so I've seen those Guardasil commercials like everyone else, so I assumed this was due to HPV. (Ironically, I am in the midst of the vaccination series.)
I asked my doctor how this was different from CIN 3, and she told me about the squamous/glandular difference and causally added that AIS was different than the type of cancer caused by HPV. I was like, "Um . . . this one isn't caused by HPV?" and she said it isn't.
When she told me this, it cleared up a lot for me. You see, I am 26. I didn't have sex until I was 25. That's right, 25. It seemed pretty strange that it could progress this quickly. (When I thought it was HPV, I went on a huge rant to my friend about how I was just going to start having sex with random strangers since being good didn't help me.)
When I first had an abnormal pap, I asked my doctor about an HPV test. She said there is no point because she'd recommend the same treatment no matter the result.
So I'm reading people's posts here about AIS, and a lot mention that they have HPV. ***? Is my doctor on crack?
That totally confuses me. From what I've read greater than 99.7% of cervical cancer (including precancerous cells) are caused by HPV.
It is entirely possible to be exposed to HPV by other genital to genital (vulva, vagina, cervix, penis, anus, rectum, mouth/throat) contact besides vaginal intercourse.
Your doctor is vaccinating you at 26? I thought the vaccine was only approved up to 25.
Yes, there is a difference between squamous (carcinoma) and glandular (adenocarcinoma) but they are both caused by high risk HPV. If she doesn't think your AIS was caused by HPV, then what does she think caused it?
AIS is actually one step above CIN III, it is generally considered a precancerous stage because cancer means invasive, and AIS is not invasive.
How long ago did you have your first pap? Do you remember what the results were?
I'm sorry this is so choppy. I'm battling a cold and I think it is time to head to bed. I didn't want to leave your post unanswered!
AIS (adenocarcinoma in situ). Carcinoma refers to cancer. There are both benign and malignant cancers, so cancer in and of itself does not mean invasive since there are benign non-invasive cancers. It is the "in situ" or "in place" which relates to the degree of invasion. An in situ lesion is equivalent to a Stage 0 (in cancer staging). Adenocarcinoma versus squamous cell carcinoma simply delineates between the type of cell containing the cancerous changes. Squamous cell carcinoma (skin cells) or adenocarcinoma (cells from glandular tissue).
Guardasil is actually recommended for girls and young women ages 9 to 26 so you are included in this age group. Merck is also trying to get the age group changed to include women up to 45 years of age. Recent studies by Merck on over 4000 men have shown a decrease in genital warts by 90%. Hopefully the FDA will quickly approve Guardasil usage in young boys/young men as well. Treating both sexes is truly the only way to drastically reduce the spread of this virus.
It is truly unfortunate that if you had no prior sexual contact and waited until you were 25 that you still contracted the virus. This is why groups which promote celibacy for their children over vaccination are wrong. Since there is no test for men with respect to HPV a woman could be celibate, never get the vaccine and yet still get the virus from her husband. HPV is a health issue not a sex issue in my opinion.
Unfortunately your doctor is incorrect. Adenocarcinoma of the cervix is indeed caused by HPV as is squamous cell carcnoma of the cervix. I believe your doctor should have a biopsy sent for HPV analysis to determine the type you have. There are quite a number of high risk HPV strains which can cause cervical cancer but perhaps the vaccine can provide you some protection against those which you may not have.
I agree with Pickle Eyes and Dragonfly; it is very unlikely that your AIS was not caused by HPV. It is also not something to be taken lightly, and you should go have your cone biopsy ASAP. I just had one a week and a half ago, and honestly it wasn't that bad. Adenocarcinoma is a sneaky thing, and you want to be accurately assessed quickly so that the doctors can help you best. Keep on top of your doctor to get the report and results ASAP as well. They told me it would take 5-7 days to get the report, but I called the office the Tuesday after my Thursday procedure and they had the info for me.
I would also consider talking to a gynecologic oncologist, even at this point. Hopefully you will never really need one, and the cone will get all the bad cells, but I believe in being one step ahead, just in case. Depending on where you live, it may also be a little difficult to find one, as there aren't a whole lot of gyn onc's out there. I'd also suggest maybe seeking a second opinion with a different gyn, since yours seems to be giving you info that seems a little off. Perhaps you'd want to consider having a different doctor do your cone. But those are just suggestions! Most important is to have the procedure quickly.
Good luck with your cone, and please let us know how you make out. I wish you all the best!!!
Thanks for your answers. I guess I will have to follow up with my doctor on this issue.
This was my first pap smear ever. (I know, I am bad.) But since I wasn't having sex, I didn't think not going was that huge of a risk. And I hate doctors. My gyno also thinks I have high blood pressure, but I explained that it's just like that when I'm in her office!
I love my doctor. Seriously, she is really great. She went to a majorly excellent medical school and now practices as a professor at another one. Plus, I call and email her like 7 times a day lots of questions and ask really specific stuff. She answers most questions, but sometimes has to get back to me because I ask her for a lot of percentages that she doesn't know off the top of her head.
I'm having the cone Feb. 3.
Last edited by LilyL21; 01-25-2009 at 07:50 AM.
High blood pressure occurring when a person visits their doctor is referred to as "white coat hypertension". It is actually quite common and relates to the anxiety the individual experiences typically from fear of the examination or the results. Perhaps you can try to test yourself in a less stressful environment. Many pharmacies have free blood pressure testing machines these days. This would give you a more realistic baseline to go by in the future.
She said she was sorry for confusing me. She said that 100% we can say for sure that HPV causes squamous cell cancer. And about 95% of women with AIS will test positive for HPV. But, she would never say HPV "causes" AIS like it causes squamous cancers.
She said it's thought by many that HPV causes AIS, but that another theory is that abnormal glandular cells provide a great place for HPV to invade. Thus, when a woman is infected with HPV (and I think everyone here is aware that it's when and not if), the HPV remains instead of "clearing" and also makes the progression abnormalities speed up.
No. She said that she'd recommend the same treatment no matter the results. Also, she said she they usually don't test women under 30.
Should I get one? I really don't see the point either. I was thinking that I'd ask for one in the future to see if it's still around. Actually, that's a good question to ask my doctor: I wonder what the possibility is that my body could still clear itself.
Also after my cone, I'm defintely going to see a gynocological oncologist. No matter even if my doctor says I have clear margins. I want someone else to repeat to me all the info.
HPV testing is still advisable. While your doctor is right in the sense that treatment would be the same regardless of the strain of high risk HPV if you have one that is not covered by Guardasil you may want to get the vaccine to at least help protect you again the others you don't have.
While HPV can go "dormant" which some people refer to as "clearing itself" the virus never truly goes away. I'm never sure when people make that statement if they understand that clearing itself really refers to being in a latent or dormant phase. HPV can return months, years or even decades later.
Just wanting to wish you good luck during your surgery. I had the cone last year Jan 08 because I was diagnosed with cervical cancer adenocarcinoma too. Stay on top of all of your follow ups afterward. I am awaiting my results to my pap from last week. Good Luck!
I am already getting the vaccine. Have had 2 shots already and the 3rd will be in April.
Oddly, having this be HPV related makes me feel better. Like I said, The possibility I have had HPV for more than about a year and a half is extremely low. While it's possible, I am highly optimistic that this has not passed the "in situ" phase.
Thank you so much. I'd love to talk more. I'm really hoping not to have anything more extensive than the cone. My doctor said the recurrence rate for AIS is 5-10%, but gets a bit higher (like 15%) when you get to about 15 years. Still, I feel like I am young and in good health. I'm going to keep doing stuff like eating my vegetables and getting exercise. Plus my boyfriend, who is absolutely adorable, has me doing all these visualization exercises about fighting off all the naughty cells. I know that none of this can cure me, but I feel like I have the power to put myself into the category of more than 90% of women who do not have recurrences.
I had BOTH sqamous and adenocarcinoma about 17 years ago. They couldn't believe I had both at one time. Insitu. I didn't know there was a recurrance rate. How are you followed? I only have a Pap. Should I be seeing a gyn. oncologist?